Work Permit 2.13

DocuSign Envelope ID: 5514B77B-8C6B-40B1-9B83-52CA5D0E7C91
______________________________________________________
WORK PERMIT NUMBER
(MM/DD/YY) Start Date:

(MM/DD/YY)
02/13/2022
DO / PO #
SAFETY, HEALTH & ENVIRONMENT DEPARTMENT (MM/DD/YYYY)
WORK PERMIT PO12415405

End Date: 02/13/2022
(MM/DD/YYYY)
Location (Site - Area): Dressing halal
Work to be done by: 3PL Sky industrial ULP
Brief description of work: Preventive maintenance all acu
TYPE OF WORK Based on JSA, check the applicable work. Activity that falls under the category below needs add'l attachments.
Dismantling/Demolition Excavation Proccess & Line Break-In/Impairment Others: No attachment required
P. M
Electrical Works (eg Near Live parts) Handling of Hazardous Materials Work on Major Lifts/Hoist
Entry to Confined Space Hot Works Working at Heights

Will this activity be done with other contractors? Yes X No none
If yes, please mention in the box provided the name of contractor and the nature of work
That I have been briefed on safe work procedures & understood all the conditions applying to the job and that no works than the work
PERSONNEL UNDERTAKING THE JOB
activity specified will be carried out
Name Role & SHE Badge # Signature Name Role & SHE Badge # Signature
Ronald bayas C21-0023 tech
Joseph aranaz C21-0024helper
Jey banania C21-0026 elec
If the box is not enough, please accomplish & attach "Page 4 continuation List of Personnel Undertaking the Job" sheet.
HAND POWER & OTHER TOOLS

Properly maintained & in good condition. Inspected & LOTO POINTS SERIAL NO. (SS-LL-EE-##)
approved by FME.
Tools / Equipment Tag Control # Tools / Equipment Tag Control #
HAND DRILL EXTENSION CORD
GRINDER
OTHERS: First Aid Kit Fak2022-008
Signatories confirm having read and understood & accept their responsibilities as defined by the Work Permit System.
1. Accepted by (Work to be 2. Authorized Person (s): 3. Reviewed by: 4. Approved by
done by): 11 February 2022 11 February 2022
11 February 2022 11 February 2022
Francis bautista aleo tuy Alejo Raquel

Raymond.Ronato Justin Angeles
3P Safety Officer / ULP Project Owner Engineering Exe / Mgr SHE Personnel Area Responsible
ALL Accomplished work permits should be submitted at the Security Gates (Paco - Gate 2, 6 or Deos Gate; Cavite - Gate 1)
SAFETY, HEALTH & ENVIRONMENT DEPARTMENT MAINTAIN GOOD HOUSEKEEPING EVERYDAY
WORK PERMIT Value Life, Value Safety
GUIDELINES
1. The contractor's management and workers should have attended the SHE & GMP (if required) Orientation.
2. Work Permit should be fully accomplished. Display accomplished Work Permit at the work site, "NO Work Permit, NO Work".
3. Work Permit is valid for 1 day only; Working hours will be from 6:00 AM - 6:00 PM only.
4. Changes or Hand-over of extended workhours should be approved by Project Owner / Facilities & Maintenance Engineering Manager / Executive.
5. Work will be stopped anytime due to Non-Compliance to the requirements / Violations to SHE Standards.
6. Dispose waste according to MSDS and company environmental regulations (DAILY). Observe Good Housekeeping (GHK)
7. After the work has been completed, accomplish "Confirmation of Completion of Work / Turnover (SHE-003)" this will be signed-off by the party who
did the job, the Project Owner & Area Owner. This should be attached to the invoice.
The workplace was visited (together with the Project Owner) & all hazards associated with the proposed
JOB SAFETY ANALYSIS (JSA)
work & the workplace have been identified, assessed and controlled;
TASKS SAFETY & ENVIRONMENTAL RISKS SAFE PRACTICES
(Detalyadong pagkakasunod-sunod ng mga (Posibleng panganib, injury o pagkakasakit ng manggagawa at (Mga gagawin upang maiwasan ang panganib)
gagawin kabilang ang mga gagamitin epekto sa environment na maaring mangyari habang ginagawa
equipment, tools, etc.) ang naturang task) CONTROLS DEFENCE
Preperation of tools and equipment Madulas, matapilok, mabaksakan nanag dalang gamit Proper wear ppe. Safety shoes, hard
nedded in the working place Proper handling hat, gloves,
tools and equipment. Googles, push cart
Coordinate to area resposible or Madulas, matapilok Proper wear ppe. Safety shoes, hard
project owner Coordinate before hat, gloves,
and after work. Googles, push cart
Turn off Power supply Makuryente Double check if Safety shoes, hard
power supply is off hat, gloves,
and put loto Googles, loto
Baklasin a ang cover upang Madulas, matapilok, maipit ang daliri, masugatan Proper wear ppe. Safety shoes, hard
malinisan ang unit. Only authorized hat, gloves,
person due task. Googles,
After malinisan ibablik ang cover Madulas, matapilok, maipit ang daliri, masugatan Secure the area Safety shoes, hard
na binaklas before and after hat, gloves,
work. Proper ppe. Googles,
Test run and observe Madulas, matapilok, maipit ang daliri, masugatan Secure the area Safety shoes, hard
before and after hat, gloves,
Conduct 5's Madulas, matapilok Secure the area Safety shoes, hard
before and after hat, gloves,
To be accomplished during work proper

SITE INSPECTIONS OBSERVATIONS:
Inspected by
Time Inspected Observations Actions Done
(Name & Signature)
HAND OVER OF EXTENDED WORKHOURS

START TIME: END TIME:
The new "Project Owner" must satisfy themselves that all the
required precautions is still in place & remain valid.
Valid up to 10pm only.

Project Owner's Signature over printed Name
WORKPERMIT CANCELLATION
Remarks:
The job described in this permit has not been executed.
This permit will be cancelled.

END OF DAY WORK CHECK (To be accomplished by 3P Safety Officer and ULP Project Owner after work for the day has been completed)
CONTRACTOR'S PERFORMANCE RATING
WORK CURRENT STATUS
(Encircle number to rate contractor's performance, 5 - Highest; 1 - Lowest)
-- To be accomplished by 3P Safety Officer -- --- To be accomplished by Project Owner ---
Acknowledged By:
CRITERIA RATING REMARKS
3 4 5
A. SHE Compliance 1 2 3 4 5
B. Quality of Workmanship 1 2 3 4 5
C. Delivery of Commitment 1 2 3 4 5
…Page #4 Continuation List PERSONNEL UNDERTAKING THE JOB

Name Role & SHE Badge # Signature Name Role & SHE Badge # Signature
…Page #5 Continuation List JOB SAFETY ANALYSIS (JSA)

(Detalyadong pagkakasunod-sunod ng mga (Posibleng panganib, injury o pagkakasakit ng manggagawa at epekto (Mga gagawin upang maiwasan ang panganib)
gagawin kabilang ang mga gagamitin equipment, sa environment na maaring mangyari habang ginagawa ang naturang
tools, etc.) task) CONTROLS DEFENCE

gagawin kabilang ang mga gagamitin equipment, sa environment na maaring mangyari habang ginagawa ang naturang
(Detalyadong pagkakasunod-sunod ng mga (Posibleng panganib, injury o pagkakasakit ng manggagawa at epekto

gagawin kabilang ang mga gagamitin equipment, sa environment na maaring mangyari habang ginagawa ang naturang CONTROLS DEFENCE



Certificate Of Completion
Envelope Id: 5514B77B8C6B40B19B8352CA5D0E7C91 Status: Completed
Subject: Please DocuSign: WORK_PERMIT Francis bautista
Source Envelope:
Document Pages: 9 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 Miguel Pasiola
AutoNav: Enabled Unilever House
EnvelopeId Stamping: Enabled 100 Victoria Embankment
Time Zone: (UTC+08:00) Beijing, Chongqing, Hong Kong, Urumqi London, EC4Y 0DY
Miguel.Pasiola@unilever.com
IP Address: 122.2.252.137
Record Tracking
Status: Original Holder: Miguel Pasiola Location: DocuSign
11 February 2022 | 19:44 Miguel.Pasiola@unilever.com
Signer Events Signature Timestamp

Francis bautista Sent: 11 February 2022 | 19:45
Completed
Francisbautistasky@gmail.com Viewed: 11 February 2022 | 19:46
Security Level: Email, Account Authentication Signed: 11 February 2022 | 20:04
(None) Using IP Address: 122.2.252.137
Signed using mobile
Electronic Record and Signature Disclosure:
Accepted: 11 February 2022 | 19:46
ID: fe71abfd-5409-44e8-8e4d-e078b62143a3
aleo tuy Sent: 11 February 2022 | 20:04

aleo.tuy2@unilever.com Viewed: 11 February 2022 | 20:08
Unilever - Global Account Signed: 11 February 2022 | 20:08
Security Level: Email, Account Authentication
(None) Signature Adoption: Drawn on Device
Using IP Address: 203.177.67.83

Not Offered via DocuSign
Justin Angeles Sent: 11 February 2022 | 20:08

Justin.Angeles@unilever.com Viewed: 12 February 2022 | 06:48
Security Level: Email, Account Authentication Signed: 12 February 2022 | 06:48
(None)
Signature Adoption: Uploaded Signature Image

Alejo Raquel Sent: 11 February 2022 | 20:08

Alejo.Raquel@unilever.com Viewed: 12 February 2022 | 05:37
Project Manager Signed: 12 February 2022 | 05:37
Unilever - Global Account
Signature Adoption: Pre-selected Style
(None) Using IP Address: 103.91.141.2
Signed using mobile
Signer Events Signature Timestamp
Raymond.Ronato Sent: 11 February 2022 | 20:08
Raymond.Ronato2@unilever.com Viewed: 12 February 2022 | 08:24
Unilever - Global Account Signed: 12 February 2022 | 08:25
(None) Signature Adoption: Pre-selected Style

In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps

Envelope Sent Hashed/Encrypted 11 February 2022 | 19:45
Certified Delivered Security Checked 12 February 2022 | 08:24
Signing Complete Security Checked 12 February 2022 | 08:25
Completed Security Checked 12 February 2022 | 08:25
Payment Events Status Timestamps

Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on: 16 July 2021 | 20:35
Parties agreed to: Francis bautista
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DocuSign Envelope ID: 5514B77B-8C6B-40B1-9B83-52CA5D0E7C91

WORK PERMIT NUMBER

(MM/DD/YY) Start Date:

WORK PERMIT PO12415405

Location (Site - Area): Dressing halal

Work to be done by: 3PL Sky industrial ULP

Brief description of work: Preventive maintenance all acu

Dismantling/Demolition Excavation Proccess & Line Break-In/Impairment Others: No attachment required

Entry to Confined Space Hot Works Working at Heights

Joseph aranaz C21-0024helper

Jey banania C21-0026 elec

HAND POWER & OTHER TOOLS

OTHERS: First Aid Kit Fak2022-008

Francis bautista aleo tuy Alejo Raquel

WORK PERMIT Value Life, Value Safety

To be accomplished during work proper

HAND OVER OF EXTENDED WORKHOURS

Valid up to 10pm only.

Project Owner's Signature over printed Name

-- To be accomplished by 3P Safety Officer -- --- To be accomplished by Project Owner ---

…Page #4 Continuation List PERSONNEL UNDERTAKING THE JOB

…Page #5 Continuation List JOB SAFETY ANALYSIS (JSA)

…Page #6 Continuation List JOB SAFETY ANALYSIS (JSA)

(Detalyadong pagkakasunod-sunod ng mga (Posibleng panganib, injury o pagkakasakit ng manggagawa at epekto

…Page #7 Continuation List JOB SAFETY ANALYSIS (JSA)

…Page #8 Continuation List JOB SAFETY ANALYSIS (JSA)

…Page #9 Continuation List JOB SAFETY ANALYSIS (JSA)

Signer Events Signature Timestamp

aleo tuy Sent: 11 February 2022 | 20:04

Electronic Record and Signature Disclosure:

Justin Angeles Sent: 11 February 2022 | 20:08

Electronic Record and Signature Disclosure:

Alejo Raquel Sent: 11 February 2022 | 20:08

Electronic Record and Signature Disclosure:

In Person Signer Events Signature Timestamp

Editor Delivery Events Status Timestamp

Agent Delivery Events Status Timestamp

Intermediary Delivery Events Status Timestamp

Certified Delivery Events Status Timestamp

Carbon Copy Events Status Timestamp

Witness Events Signature Timestamp

Notary Events Signature Timestamp

Envelope Summary Events Status Timestamps

Payment Events Status Timestamps

ELECTRONIC RECORD AND SIGNATURE DISCLOSURE

Getting paper copies

Withdrawing your consent

Consequences of changing your mind

All notices and disclosures will be sent to you electronically

How to contact Unilever Group:

To advise Unilever Group of your new email address

To request paper copies from Unilever Group

To withdraw your consent with Unilever Group

Required hardware and software

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